Aging Gracefully: How to Access Skilled Nursing Facilities

Marla Feinstein

Navigating insurance issues while you’re aging is a new field, particularly for our community. The good news is that bleeding disorder patients are aging—living longer—and can access more treatment options, including surgery. And they face the medical issues typically associated with aging, but sooner than people without a chronic condition. Complications from hemophilia can increase the likelihood of patients needing surgery for damaged joints or liver ailments. To help facilitate recovery while ensuring that their bleeding disorder and complications are adequately managed following surgery, a treating physician may recommend that some patients be placed in a skilled nursing facility (SNF) immediately after being discharged from the hospital.

            SNFs are ideal for patients because they provide short-term, intensive, inpatient rehabilitative services. And SNFs also have the medical and nursing expertise to provide a level of care far beyond what’s available to patients who are treated at home. These services are often critical for optimal recovery.

            Unfortunately, it has become increasingly difficult for some patients with bleeding disorders to get admitted into SNFs. The reasons for denial vary. Some SNFs have concerns about the type of specialized care that bleeding disorder patients require. Not surprisingly, the primary reason that SNFs deny access is the cost of and reimbursement for factor concentrates. This difficulty exists regardless of the type of insurance coverage (Medicaid, Medicare, or private) and doesn’t appear to be related to any other conditions patients may have, such as HIV or hepatitis C.

How to Pay for Skilled Nursing Facilities?

Understanding exactly how insurers reimburse for factor concentrates administered in SNFs is difficult. This is partly due to the limited number of patients needing the level of care provided at an SNF. It’s also partly due to lack of public information regarding how SNFs are reimbursed by private payers, while state-to-state variability makes it hard to understand Medicaid.

            In contrast, Medicare provides very specific guidelines for how SNFs will be reimbursed for factor for all beneficiaries. In general, Medicare pays for different types of care and services under Parts A, B, C, and D. The type of facility, and whether services are provided as inpatient or outpatient, defines how Medicare covers all patients.

            Generally, Medicare bundles reimbursement for all the services provided to a patient that are associated with an SNF stay, including nursing, therapy, drugs, supplies, equipment, room and board, and administration. This bundled, lump-sum payment is expected to cover all of the daily operating costs for running and staffing a post-acute care facility such as an SNF, but it doesn’t even come close to covering the high cost of factor concentrate (often exceeding $10,000 a day) for bleeding disorder patients during an SNF stay. Without receiving adequate reimbursement, the SNF will not be able to accept bleeding disorder patients.

Proposing a Partial Solution

It may be challenging for a patient to gain access to an SNF when there are limited or conflicting guidelines regarding how SNFs should bill for services. Though reimbursement for SNFs can be complex when working with any payer, for Medicare, at least, there is a legislative fix.

            The Medicare SNF statute allows certain costly, highly specialized services that SNFs do not typically provide to be billed separately under Medicare Part B.1 Services that can be billed separately include chemotherapy, radioisotopes, certain types of prosthetics, and erythropoietin for dialysis patients. National Hemophilia Foundation (NHF) seeks to add factor concentrate to the list of services that can be billed separately under Medicare Part B for patients with hemophilia and other related bleeding disorders during an SNF stay. The rationale is that providing factor concentrate to patients is comparable to the specialized services Medicare recognizes as needing separate treatment.

Advocating for Change

In 2014, over 300 bleeding disorder patients and families went to Capitol Hill in Washington, DC, to advocate and educate on behalf of Medicare beneficiaries unable to access SNFs. They came close to having bipartisan legislation introduced. Over the next year, NHF will continue to find legislators who are willing to introduce a bill that would change how factor concentrates are reimbursed for patients in SNFs, allowing people with bleeding disorders to access these facilities. We hope this will happen before NHF’s Washington Days in February 2016.

            It’s important to remember that passing legislation will take time, and will solve the issue of access only for Medicare patients who need to be placed in an SNF. Patients on Medicaid and private insurance (including employer groups, small and large group, and self-insured) may still have trouble accessing SNFs. We hope that once Medicare addresses the issue, Medicaid and private insurers will follow.

            Based largely on their experiences with Medicare, and fearing the astronomical costs of bleeding disorder patients, SNFs are reluctant to accept even patients who have other insurance. NHF has successfully placed patients with different types of insurance in a variety of facilities, when we can work with the facility and explain how to properly bill for factor. Though not ideal, educating facilities about the unique needs of the bleeding disorder community helps ensure that patients can get the care they need.

            Aging gracefully comes with its own set of challenges—especially for people with bleeding disorders. Coping with these challenges may be complicated, but the good news is that you’re not alone: there are resources to help. NHF’s public policy team has been hard at work trying to address how patients can best access the appropriate sites of care for the services they need. Although there isn’t always a clear path with simple answers, our goal is to facilitate and help ease transitions, allowing all patients to age gracefully.

Finding the appropriate skilled nursing facility takes time and resources, so be prepared. Educate yourself, payers, and the SNFs, keeping
these considerations in mind:
ACCESS
Post-acute care comes at a cost. When thinking about the type of care you need, determine who pays for what services, in what setting, and when.
1. Who pays: Types of insurance
Public
 Medicare
 Medicaid
 Dual
Private
 Individual plan
 Employer sponsored
Public–private combination

2. Type of care needed: Depends on the situation
Settings: Facility types and locations
Locations of acute care facilities include
 Hospitals
 Nursing homes
 Rehabilitation hospitals
 Hospice centers
 Long-term care hospitals (LTCH)
 Stand-alone facilities
 Determination of placement depends on
 Amount of rehab therapy patient gets
 Patient’s ability to perform activities of daily living
RESOURCES
Consider both financial and emotional resources. This process is hard on everyone: patients, families, and caregivers.
1. Financial
Short term
Long term
2. Emotional
Family, friends, caregivers
HTC social worker
Support groups
Assistance and support services
HTC providers (doctor, surgeon, physical therapist)
HTC case manager
Insurer
NHF’s public policy team

For additional information about Medicare coverage of SNFs: www.medicare.gov/coverage/skilled-nursing-facility-care.html

Marla Feinstein is a policy analyst for NHF. She is instrumental in advocating for the bleeding disorder community at the national and state level. Her current efforts focus on ensuring access to care for people with bleeding disorders. She has presented on behalf of NHF at numerous national- and community-based meetings of government and industry stakeholders.

  1. Centers for Medicare & Medicaid Services (CMS) Consolidated Billing Background: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/ConsolidatedBilling.html. CMS Overview on Skilled Nursing Facility (SNF) Consolidated Billing (CB): http://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/Index.html.

Discover Takeda’s dedication to the bleeding disorders community

There have been so many changes in our industry lately! It’s good to review names and companies in the community. Read more to learn about one company that just joined our community.

Whether you’re someone living with a bleeding disorder or a devoted caregiver, here’s some news to note: Baxalta and Shire are now part of Takeda. And while the name has changed, the factor treatments, educational programs, and robust community support you count on haven’t gone anywhere. In fact, Takeda will build on these programs to support you more than ever.

What does this mean for you? Rest assured, it’s good news
Takeda is dedicated to maintaining their commitment to providing exceptional patient support and partnering with patient advocacy organizations on the causes that are important to you. This move builds upon a legacy of leadership in hematology and a passion for helping patients embrace life’s possibilities.

Growing network of support
Takeda is committed to supporting the entire bleeding disorders community, as well as patients’ unique needs beyond medication.1,2 This includes education, support information, and plenty of inspiration from the walks, talks, and other programs you know and enjoy. To educate the community, Takeda has programs specifically designed for patients and their family members, like HELLO TALK® sessions. Takeda also works with local healthcare organizations to deliver disease state education to healthcare professionals who are new to the bleeding disorders specialty or don’t encounter these disorders in their everyday practice. You can also find helpful financial assistance information and dedicated support at the Hematology Support Center.  

On bleedingdisorders.com you’ll still find helpful information, insightful tips, and details on educational and support resources like FACTOR FRIEND™ and HELLO TOOLS® kits. You can also check out community news, events, and more to help stay connected with the community from coast to coast.

Takeda continues to support the community through these powerful resources and is dedicated to inspiring and empowering patients, caregivers, and the healthcare professionals who care for you. All to help you discover your own possibilities—and make today brilliant.

Stay connected with the community
Find educational programs and events near you and see what’s going on across the country. And this fall, you’ll be able to discover even more on the new and improved bleedingdisorders.com.

You can also join the community via these social channels: 

Takeda, with its focus on factor treatments and passionate support of the bleeding disorders community, is here to support you throughout your journey of living life with a bleeding disorder.

Meet Takeda at an event near you, or in Anaheim this fall!
With walks, talks, and other community events happening coast to coast all summer long, you’ll probably have a chance to get to know more about Takeda. Find an event near you. And, of course, there’s a great opportunity to learn more about Takeda later this year. Be sure to check out the Takeda booth and activities at the National Hemophilia Foundation’s (NHF) 71st Bleeding Disorders Conference. This year’s conference is happening October 3-5, 2019, in beautiful Anaheim, California. Takeda looks forward to spending the weekend with the bleeding disorders community, attending educational sessions, special events, and opportunities to meet and be inspired by all of you!

References: 1. Shire’s 70+ year commitment to the hemophilia community [news release]. Lexington, MA: Shire Plc; January 15, 2018. https://www.shire.com/newsroom/ 2018/january/7sossj. Accessed May 30, 2019. 2. Takeda. Patient services: hematology support center. https://www.shire.com/patients/-patient-services/-hematology-support. Accessed May 30, 2019.

Copyright ©2019 Takeda Pharmaceutical Company Limited, Lexington, MA 02421. 1-800-828-2088. All rights reserved. TAKEDA and the TAKEDA logo are trademarks or registered trademarks of Takeda. HELLO TALK, HELLO TOOLS, and FACTOR FRIEND are trademarks or registered trademarks of Baxalta Incorporated, a Takeda company.

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This is a paid public announcement from Takeda and does not constitute an endorsement of products or services. When you click on the links in this blog entry, you will be directed to the Takeda website. LA Kelley Communications always advises you to be a savvy consumer when contacting any company; do not reveal identifying information against your will.

The Sacred Pint

The sacred pint alone can unbind the tongue. James Joyce

Following up on my blog of June 30, here’s more fascinating facts about blood. This time, what contribution war made to blood transfusion services. In Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood , Rose George shares, in reference to World War II, how “London’s authorities had spent years readying for calamity on all fronts. But they had not thought it necessary to prepare any blood.” Below are excerpts from her excellent book!

  • In 1937, the English secretary of state for war had been asked what the nation proposed to do about a mass blood supply. He said, “It is more satisfactory to keep our stores of blood on the hoof.” He meant that the best way to store blood was how nature intended: inside a human body.
  • By World War II, blood transfusion had been fully accepted by the British military, which planned in prewar years to set up an efficient blood supply to its forces and operated it extremely effectively. Field Transfusion Unit trucks carried refrigerators containing 1,100 pints of fresh whole blood. [This had a very short life span!]
  • The actual emergency blood supply for London, a city of several million people, consisted of the stock kept by four London county hospitals for urgent maternity use: eight pints.
  • Yet in wartime Barcelona, Frederic Durán-Jordà, a Catalan physician, had successfully pioneered the mass collection, storage, and delivery of blood. He made blood mobile, transporting it to the front line in glass bottles in a converted fish van. Blood was withdrawn, mixed with citrate solution, then bottled. Barcelona’s blood was good for eighteen days.
  • We owe a lot to Percy Oliver: Oliver’s was the world’s first voluntary blood panel and the beginning of a shift to a model of altruistic blood donation in Britain that has endured one hundred years.
  • Dame Janet Maria Vaughan was a British physiologist, academic, and academic administrator. She researched in hematology and radiation pathology. In early April 1939, during World War II, she gathered some medical colleagues in her Bloomsbury flat; they would change modern medicine. She initiated creation of national blood banks in London, setting one up with Frederic Durán-Jordà. She used a modified milk bottle for blood collection and storage.
  • She used ice-cream vans full of her bottled blood through bombed and blacked-out streets. Most of the drivers were women.

• The war embedded the idea of blood donation in popular consciousness like nothing else had done.

• For British Major General W. H. Ogilvie, “the greatest surgical advance of this war, more important even than penicillin, is the development of the transfusion service.”

A departure from the topic of hemophilia, we are proud to promote…

This week we are taking a pause on the topic of bleeding disorders to share with you a very exciting project one of our team members has created!

Our editor of over 20 years, Sara Evangelos, has co-authored a young adult book titled Somewhere Besides Denver. We are so excited for Sara and this new book. Please read the synopsis below and check it out for yourself by visiting https://somewherebesidesdenver.com/

Denver, 1907: Three spirited teenage girls leave their homes on the prairie for a yearlong European Grand Tour. Violet and Marion, members of Denver’s social elite, yearn for more than society parties and safe marriages. Helen, a rancher’s daughter whose mother has abandoned the family, resents being an outsider. All three girls long to stretch the limits of what’s “suitable” for young women.

In Paris, the teens escape their chaperone and explore the city’s seamy side. Marion falls hopelessly in love with her drawing tutor, who has a history of breaking pupils’ hearts. Violet meets a chic clothing designer who encourages her to follow a career in fashion—and to ditch the corsets. In London, during the 1908 Olympics, Helen conducts a secret bicycle search for her long-lost mother, and the girls join the growing suffrage movement, barely escaping a melee at a women’s rights demonstration.

During their travels, the teens ride the Twentieth Century train and sail on the Lusitania. They meet a radical suffragette, two nosy gossips, a ground-breaking African artist, a fascinating photographer, and some fancy-dressed dogs in jeweled outfits. By the time they sail home to America, Marion, Violet, and Helen have found the confidence they need, at a time when women craved freedom—but men held the power. They decide to rebel against society’s rules, and to follow their own paths as women of the new century.

Visit https://somewherebesidesdenver.com/ for more information!

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